Brian Altonen, MPH, MS

Chikungunya Cases Double in CaribbeanNBCNews.com-Jun 5, 2014… Vincent and the Grenadines, and Saint Maarten),” they wrote in theCDC’s … “As of May 30, 2014, a total of 103,018 suspected and 4,406 … Officials have been cautioning that the virus could become established in the U.S. …Mosquito-Borne Chikungunya Virus Spreads in the Americas
Medscape-Jun 6, 2014 The next mosquito-borne infection you might want to start worrying …
Washington Post-Jun 5, 2014 Chikungunya Cases Increase in the Americas
Guardian Liberty Voice-Jun 7, 2014 Mosquito-borne chikungunya cases double in Caribbean
WXIA-TV-Jun 5, 2014 Mosquito-borne virus a public health nuisance
In-Depth-San Jose Mercury News-Jun 4, 2014

The Diffusion of diseases in this country follow several spatial patterns and abide by specific temporal patterns.  

   The simplest spatial model for diffusion is the radial or linear process with follows either just the air and is impacted by wind flow patterns (radial), or travels a natural route of least resistance such as through a gully, along a woodlands edge, parallel to roadways and animal migration routes (linear).

   A more complex spatial model follows human migration and travel patterns and certain commercial or economic paths.  The most human dependent ironically abide by many of the same patterns that inventions and discoveries tend to follow.  They hierarchically diffuse from one area to the next, going from large population area to large population area and then back-tracking to smaller areas between these major landing or outbreak areas.

   In some cases, especially when poverty becomes a major issue in how a disease develops, a reversed hierarchical pattern develops.  That is to say they at first behave hierarchically, moving from one large area to the next, but each time they reach a new population center, they infect the most susceptible populations.  In most urban settings, for numerous regions low income, low socioeconomic status neighborhoods become the places where many of these disease develop, or adapt to human population features and human behaviors to help find the next susceptible victims.  Cholera is an example that migrates internationally in this fashion.  The most susceptible areas and people are typically low income groups residing in low property value settings (poor managed, filthy, least desirable living places.)

   The temporal pattern of disease flow is related to how it travels and at what rate across the earth’s surface.  As recent diseases making their way to the United States from other countries demonstrate, distance is no longer a deterrent to international disease spread.  Even Australia, more than 10,000 miles away from the center of the U.S., is capable of sending its next disease or vector to the U.S.

   This review of how diseases that make their way to Chicago fits the current dilemma we are in with international disease migration patterns and concerns.  The spread of MERS into the more southern midwestern regions of the U.S., demonstrates a possible mixed diffusion pattern.  The early stages appear to be linear or radial in nature based on transportation routes, but should this disease take off and produce an outbreak, hierarchical diffusion patterns are expected as well.

News about the United States cases of MERS is at the CDC site http://www.cdc.gov/coronavirus/mers/US.html

The status of health care in Saudi Arabia was detailed in the conference presentation:  

HEALTH CARE DATA IN SAUDI ARABIA:  CHALLENGES IN COLLECTING, SHARING, AND APPLYING, by Mohammed Al-Kelya MS, PhD  and Abdulaziz Al-Saggabi, MSc, PharmD (http://www.ispor.org/meetings/neworleans0513/releasedpresentations/FORUMArabicNetwork.pdf&nbsp😉

WHO has reviewed healthcare in Saudia Arabia and presented its conclusions  at Eastern Mediterranean Health Journal – Health care system in Saudi Arabia: an overview, http://www.emro.who.int/emhj-volume-17/volume-17-issue-10/article-11.html

In a 2008 article published in the Lancet about disease penetration due to tourism and travel, a complete review was provided for diseases from Saudi Arabia and elsewhere,

Lin H. Chen, and Mary Elizabeth Wilson.  The Role of theTraveler in Emerging Infections and Magnitude of Travel,  Med Clin N Am 92 (2008) 1409–1432.  doi:10.1016/j.mcna.2008.07.005.

available in its entirety at http://download.thelancet.com/flatcontentassets/H1N1-flu/epidemiology/epidemiology-1.pdf

Older people with comorbidities are at the highest risk of infection and mortality from this diagnosis.   For more, see "Health officials keep close watch over MERS as potential pandemic", in 

Infectious Diseases in Children, September 2013, at http://www.healio.com/pediatrics/news/print/infectious-diseases-in-children/%7Bf9c3c3e0-0c66-45e5-a024-5256240113e5%7D/health-officials-keep-close-watch-over-mers-as-potential-pandemic

As many as 17 million people per year travel out of Saudi Arabia to other parts of the world.  High migration rates for people and high mortality rates for the virus (30-50%) are the makings for a potential pandemic, according to some writers.

For more on migrating disease patterns, see also:

Infectious Disease Movement in a Borderless World:: Workshop Summary, by Forum on Microbial Threats, Board on Global Health, Institute of Medicine.  National Academies Press, Washington, D.C.  Preview available at http://books.google.com/books?id=TJZhAgAAQBAJ&lpg=PT67

INFECTIOUS DISEASES RELATED TO INTERNATIONAL TRAVEL AND MIGRATION: PART I .  By George A. Wistreich, RC Educational Consulting Services, Inc, PDF accessible at http://www.rcecs.com/MyCE/PDFDocs/course/V7104.pdf

2009 Teen Motorcycle Accident StatisticsUnfortunately, we are not as up to date with teenage motorcycle accidents as we are for other teen motor vehicle accidents.In 2009, 205 young motorcyclists (ages 15 to 20) were killed, and an additional 5,000 were injured.Of the young motorcycle riders who were fatally injured, 26% were not wearing helmets.Of the young motorcycle riders who were fatally injured, 39% were either unlicensed or driving with one that wasn’t valid.Teen Drivers, Cell Phones, and Texting32.8% of high school students nationwide have texted or e-mailed while driving.12% of distracted drivers involved in fatal car accidents were teens ages 15 to 19.Talking on a cell phone can double the likelihood of an accident and can slow a young driver’s reaction time to that of a 70-year-old.Drivers under the age of 20 make up the largest percentage of distracted drivers.56% of teens admit to talking on cell phones while driving.13% of teens admit to texting while driving.34% of teens age 16 and 17 admit that they send and respond to text messages while driving.48% of kids ages 12 to 17 report being in a car when the driver was texting.

GIS has innumerable applications to population-season-climate-public health monitoring activities.  Temporal changes and latitudinal (seasonal temperature migration) changes are the first that come to mind, but influences of the environment upon human behaviors and peoples’ health are just as important.  Disease in-migration patterns need to be monitored.  Animal born disease patterns can undergo change overnight, without adequate warning signs.   

Climate change over time, such as global warming, accelerates those changes already in place, and adds more to the agenda for research teams trying to monitor regional change patterns.  Thus the need to have a very successful GIS program in place for monitoring these public health statistics.  

Two international/governmental documents worth exploring on this topic:

STATISTICAL COMMISSION and ECONOMIC COMMISSION FOR EUROPE.   CONFERENCE OF EUROPEAN STATISTICIANS.  "Draft recommendations on climate change related statistics."  Presented at the Third Meeting of the 2013/2014 Bureau Geneva (Switzerland), 28-29 January 2014.    ECE/CES/BUR/2014/JAN/18.   8 January 2014.  Prepared by the Conference of European Statisticians’ 

Task Force on Climate Change Related Statistics.  8 January 2014

Accessible at http://www.unece.org/fileadmin/DAM/stats/documents/ece/ces/bur/2014/18-Draft_recommendations_on_climate_change.pdf

and,

IPCC WGII AR5 Summary for Policymakers.  

http://ipcc-wg2.gov/AR5/images/uploads/IPCC_WG2AR5_SPM_Approved.pdf

An excellent GIS tool to look into for supplementing the responsibilities of Managed Care.

No county could be located that had a 100% score for local team support.  

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Allegiance or devotion to a former home or distant team was found in several expected places such as Florida (NY’ers winter paradise) and the Boston Red Sox-NY Yankees border in upstate NY.

Unexpectedly, Utah also has its own major followings for each of these teams.  South Carolinians on the other hand were split between NY and Atlanta.  

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The best scoring local support that I could find (and by "local", I mean from the diamond to the neighboring teams’ territorial edges) was Boston Red Sox (86%), followed by St. Louis Cardinals (85%).  [However, territorial area was not evaluated!!]

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This interactive mapping tool, (for now, April 30th 2014), can be found at http://www.nytimes.com/interactive/2014/04/24/upshot/facebook-baseball-map.html#4,43.328,-74.795

Brian Altonen’s insight:
The pictures provided here (minus the descriptive text) are from the AMA’s "family health magazine" Hygeia, published in 1944.
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The problem as it existed at this time is discussed in detail in Mark Graczyk’s "HIDDEN HISTORY: Polio outbreaks hit area, 1939 & 1944."
http://thedailynewsonline.com/blogs/mark_my_words/article_03cf064a-e8ce-11e2-8327-001a4bcf887a.html 
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The magazine Hygeia was devoted to health and targeted the average American households (not to be confused with a contemporary journal bearing the same name, published in India). The title Hygeia was in use from 1923 to 1949, after which it was renamed Today’s Health (1950-1976).
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More on the Polio vaccine and its history can be found at the History Channel: http://www.history.com/this-day-in-history/polio-vaccine-trials-begin
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"The Charbor Chronicles". Saturday, April 26, 2014. "On This Day in History – April 26 Polio Vaccine Trials Begin" at http://charbor74.blogspot.com/2014/04/on-this-day-in-history-april-26-polio.html
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Smithsonian National Museum of American History wepage. "Whatever Happened to Polio? " http://amhistory.si.edu/polio/virusvaccine/clinical.htm
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Polio Eradication – Global Status and Progress. UNICEF. at http://www.unicef.org/media/media_18981.html

The current technology exists to monitor child abuse, bullying, adult abuse, or any form of abuse and mistreatment using a basic statistical program.  We do not need a GIS to map many of the conditions that should be monitored by a managed care system, just the right knowledge and manpower.  

Unfortunately, many companies choose to not engage in this very detailed review of the healthcare that our population receives.  This is either because we lack the desire to engage in this work, think we lack the software to accomplish such a brutal endeavour, or believe we haven’t got the manpower we need to accomplish it.  

All of these limits we place upon our self in managed care.  Either we place them upon ourselves, or higher up decisions limit us from reaching these potentials.  Some of the most important social issues in medicine and public health are poorly managed due to this lack of engagement.

In some of my past discussions with student about population health monitoring, I referred to a successful GIS that is already operating and managing several hundred metrics or more per month as our "sixth sense."
Even when nothing appears in the forefront about health matters, viewing the images you are used to seeing every day  can often bring about new attention whenever a new health problem is surfacing, and its appearance on the map suddenly changes.
This is the major reason GIS works better for population health analyses and surveillance than any other method out there that is predominantly word or table based.
On a single page, single screen, one can review several dozen outcomes in just a few seconds.  This rapid processing is what enables us to utilize these methods as a ‘sixth sense" approach to analyzing population health.